Close the Medigap Act of 2025
Sponsored By: Representative Doggett, Lloyd [D-TX-37]
Introduced
Summary
Expands guaranteed-issue rights for Medigap. This bill would make it harder for Medigap insurers to deny coverage or exclude preexisting conditions and would restore first-dollar coverage while adding pricing limits, clearer plan data, and broker reporting.
Show full summary
- Medicare beneficiaries would gain broader access to Medigap policies. Denials, underwriting, preexisting condition exclusions, and many waiting periods would be prohibited with full implementation phased in by January 1, 2031.
- Insurers would face stricter pricing standards and periodic medical loss ratio reviews. Minimum MLRs stay at 75% for group policies and 65% for individual policies before 2026 and for periods starting January 1, 2026 MLRs could not be lower than those levels or NAIC-recommended percentages.
- Consumers would see richer plan information on the Medicare Plan Finder like provider networks and out-of-pocket estimates with periodic updates starting by January 1, 2026 and annual public comment. Brokers would need to file annual transparency reports on payments and transfers with a 12-month kickoff period.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
First-dollar Medigap coverage returns
The bill would remove the rule that blocks first‑dollar Medigap coverage. If enacted, some Medigap plans could pay costs from the first dollar, which could lower your deductibles and copays if you buy those plans.
No health-based denials for Medigap
If enacted, Medigap insurers would not be allowed to deny you a policy, add waiting periods, or charge more because of your health, past care, or genetic information. This would apply to policies effective on or after January 1, 2026, with a phase‑in of up to five years and full effect by January 1, 2031. It would not apply if you have Part A only because of section 226A. For employer group policies, issuers could adjust for a person’s manifested disease where allowed, but could not treat that as genetic info about others. HHS would also run an outreach plan, working with consumer groups, brokers, insurers, NAIC, and State Health Insurance Assistance Programs, to explain these changes.
Better Medicare Plan Finder and broker reports
CMS would review and update the Medicare Plan Finder by January 1, 2026, and then on a regular schedule. The site would show provider networks and a clear breakdown of deductibles, copays, coinsurance, premiums, and estimated yearly costs, plus state guaranteed‑issue rules before January 1, 2026. CMS would add tools to compare premiums by location, explain plan value, show issuer financial strength and policy inflation, and take public comments within 6 months of enactment and every December 7, with updates within 12 months after each comment period. Within 12 months of enactment, Medigap insurers would also have to report each year what they pay brokers and agents, and those reports would be public.
Fairer Medigap pricing and value rules
Starting January 1, 2026, HHS would seek updated NAIC standards so Medigap prices are not set by age, by parts of a county, or in ways that block access for certain eligible groups. These pricing rules would apply to people who first get Part A or first enroll in Part B on or after that date. For medical loss ratio, before 2026 group plans must spend at least 75% and individual plans 65% of premiums on care. From 2026 on, the minimum would be the higher of those floors or the NAIC‑recommended percent, so more of your premium would go to medical care.
Sponsors & CoSponsors
Sponsor
Doggett, Lloyd [D-TX-37]
TX • D
Cosponsors
Bishop
GA • D
Sponsored 1/22/2025
Carson
IN • D
Sponsored 1/22/2025
Rep. Casar, Greg [D-TX-35]
TX • D
Sponsored 1/22/2025
Casten
IL • D
Sponsored 1/22/2025
Rep. Chu, Judy [D-CA-28]
CA • D
Sponsored 1/22/2025
Rep. Cleaver, Emanuel [D-MO-5]
MO • D
Sponsored 1/22/2025
Cohen
TN • D
Sponsored 1/22/2025
Rep. DeLauro, Rosa L. [D-CT-3]
CT • D
Sponsored 1/22/2025
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 1/22/2025
Espaillat
NY • D
Sponsored 1/22/2025
Fletcher
TX • D
Sponsored 1/22/2025
Rep. Garamendi, John [D-CA-8]
CA • D
Sponsored 1/22/2025
Rep. Garcia, Sylvia R. [D-TX-29]
TX • D
Sponsored 1/22/2025
Grijalva
AZ • D
Sponsored 1/22/2025
Rep. Jayapal, Pramila [D-WA-7]
WA • D
Sponsored 1/22/2025
Johnson (GA)
GA • D
Sponsored 1/22/2025
Rep. Kaptur, Marcy [D-OH-9]
OH • D
Sponsored 1/22/2025
Khanna
CA • D
Sponsored 1/22/2025
Rep. Lee, Summer L. [D-PA-12]
PA • D
Sponsored 1/22/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 1/22/2025
Ocasio-Cortez
NY • D
Sponsored 1/22/2025
Rep. Pressley, Ayanna [D-MA-7]
MA • D
Sponsored 1/22/2025
Rep. Ramirez, Delia C. [D-IL-3]
IL • D
Sponsored 1/22/2025
Schakowsky
IL • D
Sponsored 1/22/2025
Rep. Sherman, Brad [D-CA-32]
CA • D
Sponsored 1/22/2025
Rep. Takano, Mark [D-CA-39]
CA • D
Sponsored 1/22/2025
Rep. Tonko, Paul [D-NY-20]
NY • D
Sponsored 1/22/2025
Rep. Veasey, Marc A. [D-TX-33]
TX • D
Sponsored 1/22/2025
Rep. Watson Coleman, Bonnie [D-NJ-12]
NJ • D
Sponsored 1/22/2025
Rep. Williams, Nikema [D-GA-5]
GA • D
Sponsored 1/22/2025
Rep. García, Jesús G. "Chuy" [D-IL-4]
IL • D
Sponsored 1/22/2025
Crockett
TX • D
Sponsored 1/23/2025
Rep. Hoyle, Val T. [D-OR-4]
OR • D
Sponsored 1/23/2025
Rep. Titus, Dina [D-NV-1]
NV • D
Sponsored 1/23/2025
Rep. McClain Delaney, April [D-MD-6]
MD • D
Sponsored 2/4/2025
Mfume
MD • D
Sponsored 2/10/2025
Sewell
AL • D
Sponsored 2/10/2025
Rep. Jacobs, Sara [D-CA-51]
CA • D
Sponsored 3/3/2025
Rep. Nadler, Jerrold [D-NY-12]
NY • D
Sponsored 3/6/2025
Rep. Johnson, Julie [D-TX-32]
TX • D
Sponsored 3/25/2025
Rep. Lynch, Stephen F. [D-MA-8]
MA • D
Sponsored 4/10/2025
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 2/2/2026
Roll Call Votes
No roll call votes available for this bill.
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